Requirements for Neighborhood Stabilization Program (NSP) Low-Income Housing 2015

Transcription

1 Name of Applicant Date Received 4515 Babcock St Palm Bay Fl Mail: PO Box 1253, Melbourne, FL Fax: Requirements for Neighborhood Stabilization Program (NSP) Low-Income Housing 2015 Community of Hope s NSP Low-Income Housing is restricted to households earning under <50% of Area Median Income (see chart below) and to families with children who are living with them. Income must be certified following third-party verification procedures established by NSP. Current Income Limits (effective 2015) # of Persons in Household Low Income $24,800 $27,900 $30,950 $33,450 $35,950 (up to 50% of AMI) The Rent for all properties includes a utility allowance. Any utility use over the stated allowance will be the responsibility of the tenant. Leases are for a period of one year. Monthly rental rates are as follows: Property Address No. of Bedrooms Monthly Rent 1348 Ashwood Dr. Melbourne, Fl $700 All members of the household must read and sign the Drug/Alcohol and Weapon Policy Agreement. The following criminal activities will be cause for denial of applications: Criminal History: Misdemeanors involving unlawful use or possession of firearms, illegal drugs (within the last five years), prostitution, or crimes involving a minor would result in automatic decline. Felony Convictions: Felony convictions within the past five years will result in a denial of the application. Any past felony convictions of crimes of a sexual nature, pedophilia, or crimes against minors will result in denial of the application. False Statements: Any false statements in the application process will be cause for denial. Page 1 of 5

2 Applications will be evaluated on a first come, first qualified, first served basis, so it is important to fully complete the application and submit all required documentation on a timely basis. Submit 5 page Application only when initially applying to COH. We will call you and request the other documentation. Please bring the following documents with you for your first interview: Social Security Card for each member of the family Birth Certificate for each minor Picture ID for each adult (18 years or older) Verification of Income o Pay Stubs (2 most recent) o Social Security (Eligibility Letter or other evidence of recurring monthly payments) o Bank Statements (or a written statement affirming that you do not have a bank account) o Asset verification documents Applicant/Co- Applicant General Information Full Name: Maiden Name/s or Aliases: Social Security #: Date of Birth/Age: Drivers License # & State: Citizenship: Address: Phone/Cell #: Street Address: Other Household Members: Name(s) Please use Blue or Black Ink Application for NSP housing Applicant Social Security # Date of Birth/Age Co-Applicant Relationship to Applicant Is Applicant, Co-Applicant, or any other household member, age 18 or older, a full-time student? If yes, please list: Page 2 of 5

3 Does Applicant/Co-Applicant own a home? Yes No Monthly rent/mortgage: $ Why are you seeking low income housing? How to you hear about Community of Hope? Applicant/Co-Applicant Employment Information: Applicant Name: Name of Employer: Position: Supervisor Name: Supervisor Title: Supervisor Phone: Address: Fax Number: Time Employed: Pay Rate $: Hours worked per week: Pay Frequency: Annual Income (gross salary, overtime, tips, bonuses, etc.): $ Co Applicant Name: Name of Employer: Position: Supervisor: Supervisor Title: Supervisor Phone: Address: Fax Number: Time Employed: Pay Rate $: Hours worked per week: Pay Frequency: Annual Income (gross salary, overtime, tips, bonuses, etc.): $ NOTE: Attach additional sheets as necessary for all household members 18 years and over Other Sources of Income (For ALL Household Members 18 and Over, List Business or Rental Net Income, Child Support, Alimony, Social Security, Pensions, Unemployment or Workers Compensation, Welfare Payments, etc.) Name Type of Income Gross Annual Amount Total: $ Page 3 of 5

4 Assets and Asset Income (For ALL Household Members, Including Minors, List Checking and Savings Accounts, IRA, CD, Bonds, Stocks, Equity in Properties, etc.) Type of Asset Asset Value Bank/Account # Annual Asset Income Total: $ Total: $ Liabilities (For ALL Household Members 18 and Over, List Credit Card Debt, and Auto, Real Estate and Mortgage Loans, etc.) Type Credit/Loan Creditors Name Balance Owed Monthly Payment Total Annual Payments: $ I/we understand that Florida Statute 817 provides that willful false statements or misrepresentation concerning income; asset or liability information relating to financial condition is a misdemeanor of the first degree, punishable by fines and imprisonment provided under Statutes or 778 I/we further understand that any willful misstatement of information will be grounds for disqualification and immediate removal from the housing. I/we certify that the application information provided is true and complete to the best of my/our knowledge. I/we consent to the disclosure of information for the purpose of income verification related to making a determination of my/our eligibility for housing assistance. I/we agree to provide any documentation needed to assist in determining eligibility and are aware that all information and documents provided are a matter of public record. Applicant Signature Date Co-Applicant Signature Date Page 4 of 5

5 AUTHORIZATION FOR THE RELEASE OF INFORMATION I, the undersigned, hereby authorize all organizations and individuals listed below to release without liability, information regarding my employment, income, and/or assets to Community of Hope, for the purposes of verifying information provided as part of determining eligibility for housing in Community of Hope, Neighborhood Stabilization Program Permanent housing. I understand that only information necessary for determining eligibility can be requested. Types of Information to be verified: I understand that previous or current information regarding me may be required. Verifications that may be requested are, but not limited to: employment history, hours worked, salary and payment frequency, commissions, raises, bonuses, and tips; cash held in checking/savings accounts, stocks, bonds, certificated of deposits, Individual Retirement Accounts, interest, dividends; payments from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits, unemployment, disability or worker s compensation, welfare assistance, net income from the operation of a business, and alimony or child support payments. Organizations/Individuals that may be asked to provide written/oral verifications are, but not limited to: Past/Present Employers Alimony/Child Support Providers Banks, Financial or Retirement Institutions Social Security Administration State Unemployment Agency Veteran s Administration Welfare Agency Other: Agreement to Conditions: I agree that a photocopy of this authorization may be used for the purposes stated above. I understand that I have the right to review this file and correct any information found to be incorrect. Signature of Applicant/ Printed Name Date Co-applicant Printed Name Date Note: This general consent may not be used to request a copy of a tax return. If one is needed, contact your local IRS office for Form 4506, Request for Copy of Tax Return and prepare and sign separately. Page 5 of 5